Objective: Managing diabetic foot ulcers is often fragmented, while a one-stop multidisciplinary diabetic limb salvage (DLS) service offers integrated care focusing on soft tissue reconstruction and prevention. This study evaluates the efficacy of the DLS service compared with a traditional referral-based multidisciplinary system. Method: A comparative analysis was conducted with 228 consecutive diabetic foot ulcer (DFU) patients treated by the DLS service (March 2020–July 2023) and a control group of 53 DFU patients treated before the DLS implementation (December 2017–December 2019). The DLS service integrated medical optimisation, infection management, and revascularisation on soft tissue reconstruction and prevention strategies. Outcomes assessed included healing rates, time to healing, amputation rates, and recurrence rates. Results: The DLS cohort (238 DFUs) demonstrated superior outcomes, achieving a 95% healing rate within a median of 58 days. The integration of soft tissue reconstruction was pivotal in ensuring early wound healing, which reduced major and minor amputation rates to 1.1% and 5.8%, respectively, and enabled a focus on preventive strategies. This approach, including tarsal tunnel release and total contact insoles, contributed to a recurrence rate of just 6%. In contrast, the control cohort (53 DFUs) had a 68% healing rate, a median healing time of 111 days, major and minor amputation rates of 9% and 13%, and a recurrence rate of 25%. Conclusion: The one-stop multidisciplinary DLS service significantly enhances DFU care by prioritising soft tissue reconstruction and prevention strategies. This comprehensive approach not only improves healing and reduces amputations and minimises recurrence.
Feng et al. (Tue,) studied this question.